But where, asks Reem Leila, when the cold is caused by swine flu Despite strict border surveillance, quarantine procedures and public awareness campaigns, swine flu is spreading in Egypt. While officials reiterate endlessly that the virus remains mild, still they have attempted, less than successfully, to reduce occasions, including religious ones, in which large numbers of people gather. The most common piece of advice being given is that the public should avoid crowds. And that, as any inhabitant of Egypt's towns and cities who might sometimes have to do a little shopping knows, is laughable. During a recent ministerial meeting President Hosni Mubarak instructed the government "to take all necessary precautionary measures [to prevent a rapid spread of the virus] even if this means postponing the start of the school year". Schools are officially scheduled to resume on 26 September. A majority of private schools, which generally open at an earlier date, have postponed the new term. On 6 September the Ministry of Health announced Egypt's second swine flu death. Poussy Mohamed, a 25-year-old woman from Belqas village, 150km north of Cairo, was taken to the hospital on 1 September suffering from severe pneumonia. She was quarantined and given a course of Tamiflu vaccine but her condition deteriorated and she died five days later. Amr Qandil, deputy minister of health for preventive affairs, claims that Mohamed was initially treated by a private clinic. "She was transferred to hospital on 1 September and given Tamiflu but it was too late. She was not responsive to treatment." Qandil added that ministry hospitals were fully equipped to recognise the symptoms of swine flu. Egypt's first swine flu victim, a 28-year-old who is thought to have contracted the virus while on omra rituals in Saudi Arabia, was reported to have suffered other health problems prior to the infection. El-Mursi Mohamed, the deceased's father, has contradicted Qandil and accuses the hospital of negligence. "They were unable to diagnose her," he said. "They just gave her something for the cold and let her go. When we took her back to the hospital they at first suspected avian flu and sent samples to ministry laboratories but she only got worse. It took them two full days before they finally diagnosed swine flu. My daughter did not consult any private doctors and did not go to any private clinic as officials claim." Mohamed probably contracted the virus from her husband who was visiting his home on vacation from Saudi Arabia, where he works. The husband has been treated with Tamilflu and survived the virus. The British School of Alexandria (BSA) and the American School of Alexandria (ASA) have both reported cases of swine flu among students. In response, the governor of Alexandria, Adel Labib, on Monday ordered the closure of both. In a press statement Labib said that the governorate has taken all the necessary precautionary measures to deal with such an emergency and that the city's hospitals were well-prepared. Both international schools had started classes early. Minister of Education Yosri El-Gamal says the ministry's strategy for dealing with swine flu continues to rely on "awareness and the immediate and proper treatment of each new case". The Supreme Council for Higher Education has issued emergency regulations reducing class sizes in all private education institutions. Students are to be divided among more classrooms and classes will continue from 8am until 8pm. Last week the cabinet issued an official statement saying that the H1N1 virus is "still weaker than the seasonal flu virus". Meanwhile, the World Health Organisation (WHO) has said that a second wave of infections is likely and the virus "could change". The WHO advises that any variant of the H1N1 swine flu may cause respiratory complications in a significant number of victims, perhaps, it estimates, up to 15 per cent. By press time the Ministry of Health had announced that Egypt is witnessing its first swine flu victim for a pregnant woman from Sharqiya governorate. This is in addition to more than 19 cases discovered this week, bringing the total number of swine flu cases to 828, 716 of whom have made a full recovery. The Ministry of Health has allocated 99 hospitals to deal with swine flu. Four of them -- the Imbaba and Abbasiya Fever Hospitals, Abbasiya Chest Hospital and Mansheyet Al-Bakry Hospital -- are in Cairo. Just how prepared the hospitals are, however, is subject to debate. "The hospital refuses to examine us and identify whether we suffer from swine flu or not," said one patient at the Abbasiya Fever Hospital. A 35- year-old woman who spoke on condition of anonymity said: "I almost begged them to examine me and take a swab. I even offered them the cost of the test and still the hospital refused. When I resorted to the old school network all closed doors opened. The secret word here is nepotism." An informed source at the Ministry of Health who spoke to Al-Ahram Weekly on condition of anonymity was not surprised by such stories. "Nepotism is everywhere and hospitals are no exception. There are inadequate amounts of PCR for the tests. There are not enough stocks of Tamiflu." Currently, he pointed out, one pack of Tamiflu can be bought for LE450 from private clinics, though only, he suspects, by those with connections.
